Provider Demographics
NPI:1720654932
Name:SOGLIERO, KENDELL M (CRNP)
Entity type:Individual
Prefix:
First Name:KENDELL
Middle Name:M
Last Name:SOGLIERO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:PA
Mailing Address - Zip Code:15411-2000
Mailing Address - Country:US
Mailing Address - Phone:860-222-6439
Mailing Address - Fax:
Practice Address - Street 1:100 RIDGEVIEW DR UNIT 3
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1650
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023761363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care